Community Project Grant Application                        Date:  ___/___/___

Contact Name:  __________________________________  Phone:  _______________________     

Address:  ______________________________________________________________________

City:  ______________________________________ State_____  Zip:  ____________________

Amount Requested:       $__________           Period grant will cover:  ___/___/___ to ___/___/___

Project Title:  ___________________________________________________________________

Designated Fund Applying to: _____________________________________________________

• Total project budget (if more than amount requested):  $______________

            Please attach a complete budget breakdown for this project to this application. 

• Have you applied elsewhere to assist you with the funding of this project?  Yes     No  

            If yes please list the following information.

Name of Resource:   ________________  Amount Requested  $_________

Applied      Received        Pledged      Denied   

            If denied why?_____________________________________________